Transcript Donor Selection and Deferral - India HIV/AIDS Resource Centre

• Donor Selection and Deferral
Teaching Aims
• You will learn to properly select and defer the
donor taking into consideration that the donor
and patients should not suffer in any way but
benefit from the blood donation
• Learn to identify any factors that might make
an individual unsuitable as a donor, either
temporarily or permanently. And advise them
appropriately.
Donor Selection and Deferral
Donor selection is critical to the success of supply of safe
blood & its products
•
Protect the donor
- Ensures that it is safe for the donor to donate
• Protect the recipient
- Ensures that any risk of transfusion transmitted
infection or other adverse effect is minimized
Donor selection
Registration of Donor Selection has Four Major Components:
• Questionnaire about illness.
• Demographic information & consent for blood donation
• Physical examination
• Simple laboratory tests
Responsibility
Medical officer, SR/ JR posted in the
blood donation complex or camps is
responsible for determining the
suitability of the donor to donate blood.
Donor Selection
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Examination of various parameters
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Trained staff
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Controlled and validated methods
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Calibrated and maintained equipment
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Controlled materials
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All activities and outcomes are documented
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Monitoring and evaluation
Donor registration
 Must allow full identification and link to
donor to current and previous records.
 Current information with each donation.
 Must be possible to notify donor of any
abnormalities in physical exam, medical
history or post-donation laboratory
tests.
Donor registration should include
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Donation date and time.
Last and first name (middle initial if available).
Addresses.
Telephone numbers.
Gender.
Age (or DOB).
Previous deferral record must be consulted.
Confirm identification and source of identification
if possible.
Demographic data
• Donor residence, place of birth and
education
• Donors occupation
• Date of last donation, if any
Medical history
• Medical history should be taken by
trained health care professional
• It must be assured that the confidentiality
of the donor should be maintained
• Direct questions or leading questions are
allowed in the interview
Medical History
 Have you ever donated blood under a different name?
 In the past 3 months, have you donated blood?
 Have you donated platelet or plasma within 48-72
hours?
 Have you ever been refused as a blood donor or told
not to donate blood?
 Have you ever had cancer, a blood disease or bleeding
disorder?
 Have you ever had jaundice, liver disease or positive
test for hepatitis?
 Have you ever been given growth hormone?
Medical History
 Are you feeling well and healthy today?
 In the past 3 months, have you had malaria?
 In the past 1 year, have you been under a doctor’s care
or had a major surgery?
 In the past 1 year, have you received blood or had an
organ or tissue transplant?
 In the past 6 month, have you had tattoo, skin piercing
or accidental needle stick?
 In the past 1 year, have you had close contact with a
person with jaundice or hepatitis?
Medical History
• In the past 1 year, have you had a positive test for
syphilis?
• In the past have you given money to anyone to have
sex with you?
• For female donors: Are you pregnant? Or had abortion
in the past 6 months
• In the past 4 weeks, have you had any vaccination?
• In the past 3 days, have you taken aspirin or anything
that has aspirin in it?
Medical History
 Male donors: have you had sex with another male
ever?
 Female donors: have you had sex with a male who has
had sex, even one time, with another man?
 Have you ever taken clotting factor for bleeding
disorder?
 Have you had a positive test for HIV/AIDS?
 Are you giving blood to be tested for HIV/AIDS?
 Have you had any symptoms of HIV/AIDS or weight
loss?
Physical Examination
 General appearance of donor
 Determination of hemoglobin
• Autologous donor
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Hb 11-18 g/dl
All other type donors Hb 12.5-18 g/dl
 Pulse
 60-100 beats/min
 Blood pressure
 Diastolic 60-100 mm Hg
 Systolic 100-160 mm Hg
Hct 33-52%.
Hct 38-52%.
Physical Examination
• Temperature:
• Maximum 37.5 0C
• Donor weight:
• Minimum 45 Kgs
• Amount of blood to be drawn
•  55 Kg
• 45- 54 Kg
– 450ml
– 350ml
• Venepuncture:
• Inspection of the site of venepuncture
DONOR SELECTION FOR PLATELETPHERESIS
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Donor should meet all the acceptable criteria.
The weight of the donor should be >50 kg.
Should be non-reactive for all the TTIs.
Pre-procedure platelet count should be>150,000 per microliter.
 Donor should not have taken aspirin or any other platelet
inhibitor in last 48-72 hours.
 The donor should not be fasting or have had heavy food.
 Should have a prominent and easily accessible central
antecubital vein
Donation interval
 The minimum time gap between two blood
donations should be 3 months
 Interval between two Plateletphersis is 4872hrs. Not more than two procedures to be
done in a week.
 Whole blood donation must be deferred for
at least 72 hours after plateletpheresis
 In case of re-infusion failure after pheresis
procedure, donor should not donate whole
blood for 3 months
Donor Deferral on Medical History
Conditions excluded on medical
history to protect the health of recipient
 Signs/symptoms suggestive of HIV/ AIDS
 Jaundice / hepatitis
 Malaria
 Cancers
 Lung disease / tuberculosis
 Thyroid disorders
 Recent history of:
 Medication, Vaccination, Surgery
 Blood transfusion, Acupuncture
 Contact with infectious disease
 Tooth extraction, Sepsis
Conditions excluded on medical
history to protect the health of recipient
 Signs/symptoms suggestive of
HIV/ AIDS
 Jaundice / hepatitis
 Malaria
 Cancers
 Lung disease / tuberculosis
 Thyroid disorders
Minor Surgery
Major Surgery
 Blood transfusion, Acupuncture
 Contact with infectious disease
 Tooth extraction, Sepsis
Permanent
permanent
3 months
permanent
permanent
permanent
6 months
One year
6 months
6 months
6 months
Donor Deferral on Medical History
Conditions excluded on medical
history to protect the health of donor
 Anemia
 Low / high blood pressure at the time of donation
 Heart disease
 Bleeding disorders
 Epilepsy
 Rheumatic fever
 Diabetes Mellitus on Insulin
 Kidney disease
 Pregnancy
 Breast feeding
 Menstrual problems
Temporary Deferral of Donors
Pregnancy or Delivery
6 months post delivery
Abortion
6 months
Breast feeding
Cold, cough, flu,
Until baby is weaned
Chronic sinusitis
Asthmatics
Acute Renal Infection
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Until symptoms subside
No deferral unless using antibiotics
If taking medication and 1 week
after attack
One week after stopping the
treatment and when donor is
symptoms free
Temporary Deferral of Donors
(vaccination)
Small pox, polio-oral
measles, mumps, yellow fever
Rubella
2 weeks
4 weeks
4 weeks
Anti-serum for tetanus,
Diphtheria, gas gangrene, venom
etc
1 year
Rabies vaccination ( Postexposure)
1 week
Hepatitis B vaccination
Drug History
Donors taking :
• Oral contraceptives/ Analgesics (not for platelets)/
Vitamins, mild sedatives, drugs for
hypercholesterolemia may be accepted
• Isotretinoin/ Finestride- 1 month after last dose
• Cortisone – 7 days after last dose
• Antibiotics – 3 days after last dose
• For uncertain medication-Deferral at the discretion
of the screening Doctor after taking a detailed
history.
Permanent Deferral of Donors
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Cardio-vascular Diseases
Chronic infection
Ulcer disease ( GIT )
Chronic liver disease
Endocrinal disorders
Epilepsy/ Mental/ Neurological disorders
H/o Hepatitis B or C
Any signs/symptoms suggestive of AIDS such
as– Unexpected weight loss, Persistent
diarrhea, lymphadenopathy >1month
Permanent Deferral of Donors
• Chronic infectious disease: TB, Leprosy
• Any H/o a Bleeding Disorder
• H/o Cancer
• Polycythaemia vera
• G6PD deficiency
• Thalassemia/ Sickle cell anaemia. (thalassemia
trait may be accepted)
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Drug History Donors taking:
Anti-arrhythmics, anticonvulsants, anticoagulants,
cytotoxic drugs.
Private Interview
(High Risk Behaviour)
• If there is a history of multiple sexual partners
or sex with Commercial Sex Workers, the
donor should be deferred permanently.
• High risk donors such as long route drivers, jail
inmates, homosexuals, I/V drug abusers are to
be deferred permanently.
Informed consent
• That the donor has under stood all the donor
information presented, and have all his questions
been answered?
• That his blood would be tested for Transfusion Transmitted Infections(TTI).
• That if the screening tests are non reactive, he/she
may still transmit TTI.
• Whether the donor wants to be informed about
abnormal test results?
SIGNATURE____________________
DATED________________________
Documentation
The following documents are to be entered:
• Donor Screening and Registration Form
• Donor Deferral Record Register
• Donor Record Register
Donor Deferral Record Register
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Name
Age/Sex
Address
Occupation
Blood Pressure
Weight
• Hemoglobin
• First time/Repeat
Donor
• Reason for Deferral
• Period of Deferral
Donor Record Register
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Registration Number
Tube segment Number
Name of Donor
Father’s Name
Age/Sex
Address
Date of Collection
Date of Expiry
Blood Group
Signature of Doctor
Signature of Phlebotomist
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Weight
Blood Pressure
Hemoglobin
Type of Donation
VD/RD
Type of Bag
Volume of collection
Time of collection
Duration of collection
Adverse Event /comments
DONOR ARRIVES
Temporary
Deferral &
Counseling
Registration &
demographic data
Temporary
Deferral &
counseling
Temporary or
Permanent
deferral
Future
Plan
Un Successful
Low
Hb & weight
Physical
examination
Phlebotomy
OK
Permanent
deferral
Medical history &
counseling
OK to donate
Successful
Post donation
Instruction &
refreshments
Learning Outcomes
Enabled to properly select and defer the donor
taking into consideration that the donor and
patients would not suffer but benefit from the
blood donation